Abstract
The use of intensive care at the end of life continues to be common. Although the provision of palliative care has been advocated as a way to mitigate the use of high-intensity care, it is unknown whether implementation of hospital-based palliative care services is associated with reduced use of intensive care at the end of life. To determine whether implementation of hospital-based palliative care services is associated with decreased intensive care unit (ICU) use during terminal hospitalizations. This cohort study included 51 hospitals in New York State that either did or did not implement a palliative care program between 2008 and 2014. Hospitals that consistently had a palliative care program during the study period were excluded. Participants were adult patients who died during hospitalization. Data analysis was performed between January 2018 and July 2019. Implementation of a palliative care program. The primary outcome was ICU use. A difference-in-differences analysis was performed using multilevel regression to assess the association between implementing a palliative care program and ICU use during terminal hospitalizations while adjusting for patient and hospital characteristics and time trends. During the study period, 73 370 patients (mean [SD] age, 76.5 [14.1] years; 38 467 [52.4%] women) died during hospitalization, of whom 37 628 (51.3%) received care in hospitals that implemented palliative care services and 35 742 (48.7%) received care in a hospital without palliative care implementation. Patients who received care in hospitals after implementation of palliative care services were less likely to receive intensive care than patients admitted to the same hospitals before implementation (49.3% vs 52.8%; difference 3.5%; 95% CI, 2.5%-4.5%; P < .001). Compared with hospitals that never had a palliative care program, the implementation of palliative care was associated with a 10% reduction in ICU use during terminal hospitalizations (adjusted relative risk, 0.90; 95% CI, 0.85-0.95; P < .001). The implementation of hospital-based palliative care services in New York State was associated with a modest reduction in ICU use during terminal hospitalizations.
Highlights
High-intensity care at the end of life has the potential to be discordant with patient preferences and nonbeneficial.[1,2,3] both the use of intensive care during the last 30 days of life and dying in an acute care setting are considered negative indicators of the quality of end-of-life care.[4]
Patients who received care in hospitals after implementation of palliative care services were less likely to receive intensive care than patients admitted to the same hospitals before implementation (49.3% vs 52.8%; difference 3.5%; 95% CI, 2.5%-4.5%; P < .001)
Compared with hospitals that never had a palliative care program, the implementation of palliative care was associated with a 10% reduction in intensive care unit (ICU) use during terminal hospitalizations
Summary
High-intensity care at the end of life has the potential to be discordant with patient preferences and nonbeneficial.[1,2,3] both the use of intensive care during the last 30 days of life and dying in an acute care setting are considered negative indicators of the quality of end-of-life care.[4]. Palliative care programs have continued to expand nationally,[9] it is not known whether this growth is associated with decreases in treatment intensity at the end of life. The goal of this study was to assess whether the implementation of hospital-based palliative care services is associated with a subsequent decrease in the use of intensive care during terminal hospitalizations
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